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General NPI Number Information
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NPI Number | 1497319792
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Entity Type | Organization
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Legal Business Name | RENEGADES FOR LIFE INC
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1265 S MAIN ST STE 305A
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City | SEATTLE
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State | WA
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Zip | 98144-2010
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Country | US
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Telephone | 206-841-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 10245 DES MOINES MEMORIAL DR S APT 401
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City | SEATTLE
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State | WA
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Zip | 98168-1660
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Country | US
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Telephone | 206-841-3700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SALEEM ROBINSON
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Credential |
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Telephone | 206-841-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1201X
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Taxonomy Name | Optometric Assistant Technician
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License Number |
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License Number State |
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